Assessment of stool frequency and colonic transit time in Indian children with functional constipation and healthy controls

Abstract

Indian adults have higher stool frequency and shorter colonic transit time compared to the Western population. Colonic transit time has not been studied well in Indian children. We aimed to compare colonic transit time in normal and constipated children. In this prospective study, stool characteristics and colonic transit time by radio-opaque markers were studied in healthy children (group A, n = 39) and functional constipation patients (group B, n = 61). Twenty radio-opaque markers were ingested per orally at 0, 12, and 24h followed by a single abdominal X-ray at 36h. Total and segmental colonic transit times were calculated using the standard formula. Stool frequency per week and consistency were significantly different between group A (9 [2.5-17] years) vs. group B (4.5 [2-14] years), 7 (7-14) vs.1 (1-2), and Bristol type 4 (3-5) vs. type 2 (1-3). Total colonic transit time of groups A and B was 16.2 (0.6-36) vs. 22.8 (1.8-35.4) hours; p = 0.003. Ninety-fifth percentile (upper limit of normal) cutoff derived from group A was 31.8h. Ninety-two percent of group B had colonic transit < 95th percentile of normal healthy children. Despite 8% with colonic transit > 95th percentile, all group B patients responded well to standard therapy with laxatives. Indian children have significantly higher stool frequency and shorter colonic transit time, which are different compared to the reported figures fromthe West. Most of the Indian children with functional constipation had normal colonic transit time.